title: Experience with a minimally invasive approach to combined valve surgery and coronary artery bypass grafting through bilateral thoracotomies.
abstract: BACKGROUND
  Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive valve surgery (MIVS) have been used independently to manage occlusive coronary artery disease and valvular diseases, respectively. We present 12 patients who underwent combined MICS-CABG and MIVS via bilateral mini-thoracotomies.
  
  
  METHODS
  We retrospectively reviewed 116 consecutive valve/CABG operations by a single surgeon and compared the outcomes obtained via sternotomy with those obtained via bilateral minithoracotomies.
  
  
  RESULTS
  Six patients in the MIVS group underwent aortic valve replacement (sternotomy group, n = 70), 3 patients underwent mitral valve repair (sternotomy group, n = 9), and 3 underwent mitral valve replacement (sternotomy group, n = 25). The minimally invasive valve surgeries were combined with MICS-CABG for single- (n = 2), double- (n = 9), and triple-vessel (n = 1) coronary artery disease in a single operation. The mean SD duration of cardiopulmonary bypass was 164 ± 44.6 minutes (mean time via sternotomy, 152 ± 50.5 minutes; P = .4146), and the mean aortic cross-clamp time was 87.8 ± 22.1 minutes (mean time via sternotomy, 105 ± 39.8 minutes; P = .1455). The use of perioperative blood transfusions averaged to 2.3 ± 5.6 units (mean usage via sternotomy, 2.7 ± 4.9 units; P = .8326). There were no conversions to sternotomy in the minimally invasive group. Patients in the minimally invasive group were extubated earlier (24 ± 11 hours; sternotomy group, 40 ± 61 hours; P = .3684) and discharged earlier (7 ± 4 days) than patients who underwent median sternotomy (9 ± 10 days; P = .4027).
  
  
  CONCLUSIONS
  MICS-CABG combined with MIVS via bilateral minithoracotomies yielded short-term results comparable to those for CABG and valve repair via median sternotomy. There were no operative mortalities or reoperations. The possible advantages of the minimally invasive approach included earlier extubation and earlier discharge from the hospital. Combined CABG and valve surgery can be safely performed via bilateral thoracotomies.
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, New York, USA.
authors.forename: Pieter J S
authors.initials: PJ
authors.lastname: Smit
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shariff
authors.forename: John P
authors.initials: JP
authors.lastname: Nabagiez
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Khan
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sadel
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome